Culture Shock and Communication Avoiding Misadventures in Cross Cultural Relations

Congratulations, you are about to embark on a memorable and valuable experience! This guide is to help you begin to
think about and prepare for the feelings you are likely to experience during your time at your host site and to understand the
rationale behind the guidelines for communication for participants in field experiences through UWHC Graduate Medical
Education. While no two people have the same experience or react in the same way, there are general patterns that apply
to everyone. Culture shock is a well-described phenomenon that affects all travelers to varying degrees. Whether you are
a seasoned traveler or this is your first trip out of the United States, you may find that the natural adjustments that occur
during your time in your host community are amplified; you will not only be living in a new place but you will be adapting to
a new work environment.
Being cognizant of your feelings and emotions as they relate to situations you encounter during your field experience will
help you to moderate your reactions, improve your interactions with your colleagues, and walk away with a more complete
picture of the community in which you will be spending the next few weeks. Private documentation of your reflections
throughout your field experience will provide you with some protection from unnecessary cultural misunderstandings and
offenses.
Culture Shock an Overview What Is It? The loss of emotional equilibrium that a person suffers when he moves from a
familiar environment where he has learned to function easily and successfully to one where he has not. Arthur Gordon
Why Does It Happen?
Over the course of our lives, our own culture becomes deeply engrained via habitual, learned behaviors. Our culture
quickly becomes invisible to us. We believe that the way we have grown to know life is the way that it should be, it is
normal. Without knowing, our ways of living become ingrained as moral claims.
When we enter a new culture we experience an abrupt loss of familiarity. We try to understand the different norms and
guidelines that dictate life in the new culture. We are forced to re-learn how to live day to day. While we strive to do what is
appropriate, we often dont know exactly what that is. This creates a sense of social isolation and differences
subconsciously become classified as senseless, irrational or even immoral.
What are the Signs & Symptoms?
Like many conditions, the way culture shock is manifested exists on a spectrum ranging from mild uneasiness to
unhappiness to true psychological panic. While the list below is not all-inclusive, it is likely that you will experience some of
the following:
-

Frustration
Irritability
Hypersensitivity
Mental fatigue
Boredom
Lack of motivation

Physical discomfort
Disorientation about how to work with/relate to others
Suspicion (feeling like everyone is trying to take
advantage of you)
Over-concern for cleanliness
Loss of perspective

Stages of Culture Shock

There are many different versions of the stages of culture shock however they vary mostly in complexity rather than true
content. The most commonly used stages described are:
-

Honeymoon exciting, see similarities

Rejection (shock) everything feels hard, see only differences
Regression glorification of home country, critical of new, superior attitude
Acceptance/Negotiation develop routine, sense of humor returns
Reverse culture shock incorporating the new you into your old life

Distilled into its most basic form, the stages of culture shock can be simplified:
At first we think it is charming
Then we think it is evil
Then we think it is different
From William Drake & Associates, Managing Culture Shock

Reactions
Typical reactions include assuming the problem lies in everyone else (i.e. something is wrong with them, not us), overvaluing our own culture, defining our culture in moral terms (natural, rational, civilized, polite), under-valuing the new culture
and seeing it as chaotic or immoral, and stereotyping in an attempt to make the world predictable.
When Culture Shock Leads to Cultural Insensitivity

How we react to the culture shock we are experiencing is the crux of what causes well-intentioned people to display
unsavory behaviors. Culturally-insensitive and inappropriate situations arise when our behavior, actions (and reactions),
and responses reflect the stage of culture shock we are experiencing. To make matters worse, when you are feeling the
most frustrated, you have the least amount of information available to help you understand why things happen the way that
they do. While your understanding of the system will greatly increase during your time at your host site, in your short time
there it will be impossible for you to fully understand the complex set of interactions occurring simultaneously. Being aware
of your emotional reactions and always attempting to increase your understanding will not only enhance your personal
experience but also decrease the likelihood that something you do will reflect poorly on you, your colleagues and your
program.
Culture Shock and the Internet
In todays world of email, Facebook, and blogs, the public sharing of thoughts, ideas, and feelings has become
commonplace. As opposed to individualized, personal communication (phone calls or letters), these modes of
communication allow for complete transparency of thought. In the context of global health experiences and reactions to the
stages of culture shock, this level of transparency can be damaging. With an incomplete understanding of the culture in
which one is living, a well-intentioned writer may unintentionally use descriptors that are culturally insensitive or
unacceptable. As a visitor passes through the various stages of culture shock, their thoughts, perceptions, and feelings
about their host community will inevitably change. Reflecting on these emotions and experiences in a forum that could be
available to others not only poses ethical and professional dilemmas but also has the potential for lasting cultural
misunderstandings and transgressions that will impact the individual as well as the institution.
As the sharing of information becomes increasingly easy, the risk for inadvertent viewing of that same material also
increases. Far too often, communication intended for family or friends is forwarded or found by people who may not fully
understand or appreciate the context. Many forms of communication can and have been the cause of misunderstandings:
blogs, social networking websites (Facebook, MySpace, etc.), email, postcards, photo sites (Flickr, etc.), You Tube,
electronic documents, print materials, publications (local, national, etc.), and presentations (taped, not taped).
Successfully Navigating the Seas of Cultural Competence
Be aware that culture shock affects even the most seasoned and experienced traveler. All writers feel that they have been
both self-aware and sensitive as they are creating and sharing their observations. However, the process of culture shock
involves shifting perceptions of ones surroundings over time. This constantly evolving experience and the ease of
information dissemination makes the risks associated with electronic sharing of critical importance for all partners in global
health relationships.
While culture shock is an unavoidable phenomenon, understanding how the adjustment to a new culture can affect
thoughts and behaviors may allow a visitor to better moderate their reactions. Incorporating this knowledge into private and
thoughtful reflection is a key element of developing cultural competence. Combined with humility and patience this practice
can lead to meaningful, life-long relationships between global partners.
Commitment to Professionalism Communication Guidelines
First and foremost, remember that you are a visitor and a guest. Your role during your field experience should reflect this
idea. You are to uphold the highest standards of professionalism, respect, and courtesy.
Throughout your field experience you will be acting on behalf of the University of Wisconsin. Please continue to display the
professional behavior that you do here at the University of Wisconsin, paying extra mind to the cultural beliefs and views of
your hosts. You will not only be acting as an ambassador on behalf of the University of Wisconsin and the UW Hospital &
Clinics, but also of the United States. Your behavior during your field experience not only has the ability to impact the health
of the partnership with your host site, but also directly reflects upon the character of those from the University of Wisconsin.
Prioritizing the right to privacy of our host communities and individuals within those communities and a commitment to
developing culturally-sensitive collaborations, great discretion should be used when communicating details of your
experience with those outside of the host community. Details about your experience or the host site may NOT be posted
on a public blog. The use of internet-based venues as communication tools while abroad is strongly discouraged. Patient
and facility information should never be posted on-line. The same practices that pertain to confidentiality and privacy that
exist at the University of Wisconsin are to be upheld by those participating in field experiences at international sites.
Discretion should also be used when taking photographs of people, and especially of patients, during field experiences.
Participants should be mindful of their setting and the cultural appropriateness of taking photographs. Full disclosure and

transparency of purpose must be provided to those being photographed (including how the photograph may be used and
who will be able to see it) and permission should always be obtained. Prior to taking photographs, permission from the
hosting institution should be requested and information about existing photo policies should be obtained and followed.
Lastly, presentations given on return should be mindful of portraying the host community in a way that would be considered
respectful and culturally appropriate in that setting. Presentations should be reviewed with your UW Global Health Faculty
Mentor and/or the host institution prior to being delivered.
Resources and Further Reading
1.

Foster J. Cultural Humility and the Importance of Long-Term Relationships in International Partnerships. JOGNN. 2009;38:100-107.
2. Kamei R. Why Dying Doesnt Seem to Matter: The Influence of Culture on Physicians in Bali, Indonesia. Acad Med. 2003
Jun;78(6):635.
3. Koehn P. Globalization, Migration Health, and Educational Preparation for Transnational Medical Encounters. Globalization and
Health. 2006;2(2).
4. Kumagai A, Lypson M. Beyond Cultural Competence: Critical Consciousness, Social Justice, and Multicultural Education. Acad
Med. 2009 Jun;84(6):782-787.
5. Levi A. The Ethics of Nursing Student International Clinical Experiences. JOGNN. 2009;38:94-99.
6. Pedersen, Paul. The Five Stages of Culture Shock: Critical Incidents Around the World. Contributions in Psychology, No. 25.
Westport, Conn: Greenwood Press, 1995.

Web Resources
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http://edweb.sdsu.edu/people/cGuanipa/cultshok.htm
http://www.juliaferguson.com/shock.html
http://international.engr.wisc.edu/preparing/cultureshock.php
http://www.cals.wisc.edu/studyabroad/students/intl-student-incoming/cultureshock.htm
http://www.worldwide.edu/travel_planner/culture_shock.html
http://www.larissa-becker.de/culture_shock.doc
http://medicine.creighton.edu/projectcure/cultureshock.htm

Failure to identify cultural issues and take action can lead to culture shock. Often, the symptoms are
ignored or simply not recognized.
Symptoms of Culture Shock...
Productivity is negatively impacted
Employees are disgruntled and frustrated
Stereotyping affects judgment
People are unable to establish trust and good working relationships
Effectiveness of marketing efforts reduced
Ineffective exchange of information
Frequent miscommunication and misunderstandings
Difficult to attract qualified and talented workforce
Lawsuits filed by unhappy employees or dissatisfied customers

Stages of Culture Shock

First stage - incubation/honeymoon

Everything is new and exciting
Second stage - frustration in trying to adapt
Feels impatient, frustrated, incompetent, angry

Third stage - the turning point

Gains understanding, feels positive OR returns home
Fourth stage - integration
Recognizes new culture has much to offer
Fifth stage - re-entry shock
Sometimes experiences difficulty returning to own culture

Stigmatization, Tolerance and Repair. An integrative psychological analysis of responses to

deviance